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New Hampshire - Autism Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The New Hampshire Department of Health and Human Services (DHHS) Bureau of Developmental Services (BDS) oversees autism-specific interventions, including Applied Behavior Analysis (ABA), primarily funded through the Developmental Disabilities (DD) and In-Home Supports (IHS) waivers, as well as the Medicaid State Plan under EPSDT. Providers must enroll as a Group Billing Provider (Provider Type 236) through the NH MMIS Health Enterprise Portal and secure a contract or affiliation with one of New Hampshire's ten designated regional Area Agencies to receive authorizations and deliver waiver-funded care.

Approval requires registering the business with the New Hampshire Secretary of State, obtaining a National Provider Identifier (NPI), and passing a risk-based screening under He-W 520.06. Agencies delivering facility-based or residential community participation services must also obtain certification or licensure from the DHHS Health Facilities Administration (HFA) before rendering services.

1. Service Definition and Scope

New Hampshire Medicaid covers Applied Behavior Analysis (ABA) and related autism-specific interventions for eligible individuals under the age of 21 via the EPSDT benefit, and for waiver participants through the Bureau of Developmental Services (BDS). Services focus on adaptive behavior functioning and require delivery by credentialed professionals.

Under He-M 502, developmental disability includes autism, and services must be authorized in the individual's service agreement.

2. Regulatory and Oversight Agencies

Multiple divisions within the New Hampshire Department of Health and Human Services (DHHS) regulate autism service providers. The Bureau of Developmental Services (BDS) manages waiver policy, while the Health Facilities Administration (HFA) handles facility certification.

Medicaid enrollment and claims are managed by Conduent, the state's fiscal agent, through the MMIS portal.

3. Gatekeeping Prerequisites: Who Can Even Apply

New Hampshire utilizes a regional gatekeeping model for developmental and autism waiver services. Providers cannot operate independently to bill waiver services without coordinating through the designated regional entities.

Before providing waiver-funded supports, an agency must establish a relationship with the local Area Agency.

4. Licensure and Certification Requirements

New Hampshire requires specific facility certification for agencies providing community participation or residential services. Purely in-home ABA providers may not require HFA facility licensure but must ensure staff hold appropriate professional credentials.

Professional licensure for behavior analysts is managed by the Office of Professional Licensure and Certification (OPLC).

5. Medicaid Provider Enrollment

All autism and developmental service providers must enroll in New Hampshire Medicaid, even if they use a third-party biller. Applications are submitted electronically via the NH MMIS Health Enterprise Portal.

Agencies must enroll as a Group Billing Provider, and individual rendering providers must be affiliated with the group.

6. Staffing, Training and Background Checks

New Hampshire enforces strict background check requirements under He-W 520.06 for Medicaid providers. High-risk providers must undergo state and federal criminal background checks, including fingerprinting.

Agencies must also attest to monthly checks of the OIG exclusion list.

7. Documentation, Policies and Records

Providers must maintain comprehensive records of service delivery, staff qualifications, and compliance with the CMS Settings Rule. Documentation is managed partially through the NH Easy BDS Service Provider Management platform.

Agencies must submit specific enrollment forms and maintain policies on incident reporting and background checks.

8. Billing, Rates and Claims

Providers can bill New Hampshire Medicaid directly through the MMIS system or utilize an approved trading partner. Developmental services require group billing setup.

Certain services may be billed as pass-through services via an Organized Health Care Delivery System (OHCDS), though ABA typically requires direct group billing.

9. Approval Sequence and Timeline

The enrollment process is sequential, beginning with corporate registration and ending with Area Agency contracting. Providers cannot render services until all steps, including HFA certification if applicable, are complete.

Upon MMIS approval, providers receive a welcome letter and must notify BDS to schedule a consultation meeting.

10. Common Denials and Survey Findings

Applications are frequently delayed due to missing taxonomy codes, incorrect address formatting, or failure to register with the Secretary of State. The Provider Relations team from Conduent will contact applicants if information is missing.

During surveys, HFA and BDS commonly cite providers for lapsed background checks or incomplete service documentation.

11. Key Contacts and Resources

Prospective providers should utilize the DHHS New Provider and Onboarding Resources page and the MMIS portal for guidance. Technical assistance for the enrollment application is provided by Conduent.

For waiver-specific questions, providers must contact the Bureau of Developmental Services directly.

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